ES2328398T3 - ANCHORAGE GUIDE RADIALLY EXTENSIBLE FOR TROCARES. - Google Patents

Abstract

An anchor guide for a trocar comprising a tubular body, formed by a plurality of substantially circular sectors, moveable radially toward and away from a longitudinal axis of the tubular body between a first position where they flank one another, according to a first substantially circular arrangement with diameter generally equal to that of the tubular body, and a second position at which they are generally equidistant from one another, according to a second substantially circular arrangement of greater diameter than that of the first arrangement. Each sector is rotatably connected to a support element and a manual operation member is provided, moveably connected to the support element, for moving the sectors from the first to the second position and vice versa.

Description

Radially extensible anchor guide for trocars

Field of the Invention

The present invention generally relates to field of equipment for laparoscopic surgery and more particularly it refers to a radially anchoring guide Extendable for trocars.

Technical background

As is known, in the field of surgery Laparoscopy is widely used for instruments called trocars which generate and maintain access channels for the various surgical instruments used in the operations. Schematically, a commercial trocar comprises a cannula and a valve body located at one of its ends. Typically the cannula has a diameter of 5 or 12 mm with a 110-120 mm length.

At the beginning of the operation, they are performed some drills, for example, in the patient's abdomen using  several trocars equipped with an accessory capable of penetrating various layers of tissue. Next, such an accessory is extracted and inert gas is blown into the abdomen through one of the trocars so that the space necessary for the operation.

The pressure generated inside the abdomen tends to push the trocars out, therefore they have contemplated various procedures for their anchors. The solution more extended contemplates the use of a tube with a diameter inside equal to the outside diameter of the trocar cannula and with a external threaded surface in such a way that allows the surgeon "thread it" into the access hole. The tube is fixed then to the trocar cannula by elastic bands or friction systems

During operation, all instruments necessary are inserted through the trocars. In the case in the which internal parts have to be removed, for example the gallbladder biliary, parts of the intestine, tumor masses, etc., can be necessary to make additional size cuts enough for the passage of the part to be extracted. This need involves many additional wounds larger than those that leave the trocars, as well as the possibility of contamination through the walls of the cut during the stage of extraction of the parts to be removed; all this results in a more difficult recovery of the patient after the operation. After extraction, it is often necessary to continue operating laparoscopically and the additional cut compromises the tightness to gas so it is necessary to use an instrument capable of Restore tightness.

GB 330629 discloses a speculum extensible according to the preamble of claim 1 comprising a series of blades that extend axially from a housing containing a mechanism adapted to operate simultaneously the blades to deploy them in different directions from the axis, so that it extends evenly a step inside which said blades are inserted. He mechanism for deploying the blades is of the type in which the driving a screw or knob in a circular direction makes an equal and parallel outward movement of all blades

US 3789852 discloses an element Extendable tubular, especially for use as a trocar, in which one or more thin metal strips, such as for example stainless steel, are arranged to form an element tubular which can be extended in the radial direction. In In particular, the tubular element comprises a steel strip spirally wound stainless to form a tube with ends free of the tube wound that way by being mobile in the circumferential direction to cause extension and contraction of the trocar.

Summary of the Invention

The object of the present invention is to provide an anchor guide for a trocar which, taking advantage of the elasticity of the relaxed tissues (since they are anesthetized), can be extended to generate the space
necessary for the extraction of the parts to be removed without the need for additional cuts.

Another object of the present invention is provide an anchor guide for trocars of the aforementioned type before in which it is possible to mount an autonomous valve system to through which instruments or an adapter can pass commercial trocars yes, after removal of the parts affected, it was necessary to pressurize the abdomen again and start the operation again.

These objects are achieved with the guidance of anchor for a trocar according to the present invention, the main characteristics of which are defined in the claim 1.

Brief description of the drawings

Other features, as well as the advantages of the anchor guide for a trocar according to the present invention is will be clear from the following description of an exemplary embodiment and not limiting with reference to the accompanying drawings in which:

- Figure 1 is a perspective view of the anchor guide according to the invention in its closed position;

- Figure 2 is a perspective view of the anchor guide according to the invention in its open position;

- Figure 3 is a sectional view cross section of the anchor guide of figure 1;

- Figure 4 is an exploded view of the anchor guide according to the invention;

- Figure 5 is a perspective view of the anchor guide according to the invention in a completely position open and with a diaphragm valve inserted inside;

- Figure 6 is a sectional view length of the anchor guide of figure 5 car,

- Figure 7 is a sectional view length of the anchor guide according to the invention in position  closed with a commercial valve system;

- Figure 8 is a perspective view of the anchor guide according to the invention in its closed position, equipped with a diaphragm valve with a commercial trocar housed in its inside;

- Figure 9 shows a perspective view of the anchor guide according to the invention with a protective tube.

Detailed description of the invention

With reference to the figures 1-4, a tubular body, generically indicated with 1, is formed by three sectors 1a of an angular width equal to 120º. From one end of each of the 1st sectors, an arm curved 2 extends in a substantially tangential manner; he free end of the curved arm 2 is rotatably coupled with a pin 3. The three pins in turn are coupled in three equidistant 5 holes formed in a first nut round 4, called fixed round nut, orthogonal to the shaft length of tubular body 1 and circumferential notches 6 made along a second round nut 7, called mobile round nut, coaxially arranged in the round nut fixed 4. The threaded ends of the pins 3 that extend from the notches 6 of the mobile round nut 7 are finally coupled in respective threaded knobs 8, which rest against the mobile round nut 7 opposite to the nut fixed round 4, thereby obtaining mutual fixation of the various components

The three sectors 1a of the tubular body 1 form a channel of inside diameter less than or equal to the diameter exterior of the commercial trocar cannula and will be used, while the outer surface of sectors 1a has a thread of sawtooth, as in the anchor cannula of the type known, able to grip on the walls of the access drill to The body cavity.

The three curved arms 2 are housed in the inside of the fixed round nut 4, coplanar to it and simultaneously they can be turned around pins respective 3 to transmit an angular movement to the nut mobile round 7. Following the turn of the arms 2, the sectors cylindrical 1a extend from there progressively digressing widely with each other, going from closed configuration illustrated in figure 1 to the open configuration of figure 2.

Three angularly equidistant locking pins 9 and three thrust pins 10 extend orthogonally from the face of the movable round nut 7 turned towards the fixed round nut 4. When the tubular body 1 is in its closed position, as shown in the figure 1, the closing pins 9 rest on the convex side of the respective curved arms 2 and keep the three cylindrical sectors 1a adjacent to each other, tightening them on the trocar cannula so that it allows axial locking of the trocar. In particular, as shown in Figure 4, the arms 2 have seats 2a within which the locking pins 9 are coupled. On the other hand, when the mobile round nut 7 is turned in the direction of the arrow F of the Figure 3, the push pins 10 come into contact with the concave profile of the arms 2 of the sectors 1a and, sliding along them away from the articulation pins 3, ensure that the arms extend progressively. The opening of sectors 1a occurs first quickly and then slowly approach the end stop; in this way it is possible to exert a force as constant as possible through the opening stage, since the resistance of the tissues increases as the divarication of the sectors 1a increases. At the end stop, the tubular body 1 remains stably open when the push pins reach the neutral point. If it is necessary to stop the opening in an intermediate position, it is sufficient to tighten at least one of the three knobs
threaded 8.

To ensure a proper seal of the gas on the patient's side, a membrane 11 is contemplated as it is represented in figure 4 and in figure 7, while on the side the surgeon's tightness is ensured by a system of valves such as that represented in figures 5 and 7. The membrane 11 has a variable thickness and, in particular, in correspondence with its minimum and maximum diameter ends with respective toroidal rings 11a and 11b. Diameter ring maximum 11b is inserted into a perimeter groove 4a of the nut round 4, as is visible in figure 6, while the ring of minimum diameter 11a is tight at the base of sectors 1a. Do not a slot for the housing of the ring 11a, since in the correct position it is kept both because it is in a resting position as because the membrane is forced by the patient's abdomen against the round nut 4.

The radially extensible anchor guide for trocars according to the present invention is used as follows way. At the beginning of the operation, during the insertion stage of the trocar in the abdomen (for example), the anchor guide according to the This invention is used as if it were an anchor tube normal trocar in the abdominal wall. As depicted in the Figure 8, the three sectors 1a close around the cannula 12 of the trocar and tighten with it by turning the round nut mobile 7 with respect to the fixed round nut 4 and tightening so minus one of the locking knobs 8. In the particular case in which the inserted trocar is calibrated on the inside size of the closed tubular body 1, the tightening of the locking knob 8 can be avoid since the system is irreversible is in position completely closed. A valve 13, of the type illustrated in the Figures 5 and 6, close around the trocar tube to ensure A perfect gas tightness. In the case in which the valve is that illustrated in these figures, it is not necessary to press the tubular body 1 on the trocar cannula 12, since it valve can secure the axial anchoring of the trocar. Of course, when the membrane tightens around the trocar cannula, generates a constant radial force which, due to the high coefficient of friction between the same membrane and the cannula of the trocar, ensures a tight axial tightness.

If during operation it becomes necessary insert a larger trocar, it will be enough to open the valve 13 of figure 8, open the tubular body 1 by means of the unlocking the trocar cannula 12, remove the trocar to be replace, insert the new trocar and tighten the tubular body 1 and the sealing valve 13 on it.

If during operation it becomes necessary remove an internal mass, the tubular body 1 can be divaricated until its maximum expansion so that, once the trocar and the sealing valve, an access channel is generated in the abdomen of sufficient dimensions for the passage of the mass that It is going to be removed.

To protect the walls of the access hole of possible contamination (for example during the extraction of a tumor mass in the absence of other types of protections), is possible to insert into the divaricate sectors 1a a tube 14 (see figure 9) after overdrawing the membrane elastic 14a inside the tube itself. In particular, the tube 14 is composed of a rigid cylinder of a thin thickness buried inside an elastic membrane that ends in both ends with two large diameter discs with edges reinforced, one of which is membrane 14a. For insertion inside the divaricate tubular body 1, the inner disk or membrane 14a is folded inside the tube 14 and a Then it is made to expand inside the abdomen. The membrane 14a protects the inner wall of contamination from abdomen near the access drill. The axial position of the tube 14 it is ensured by tightening the three sectors 1a on the same. The tube 14 has an outer elastic disk 15 on the other end which can be folded over the mobile round nut 7 of the anchor guide so that it protects it from contamination. The Figure 9 has the extensible anchor guide according to the invention in a suitable configuration for the extraction of an internal mass. To extract the tube 14, it is sufficient to further divaricate sectors 1a and pull tube 14 through the outer disk fifteen.

The valve 13 illustrated in Figures 5 and 6 is based on the principle of operation of a commercial device called "LAP-DISC", described in the patents American No. 6110154 and 6589167 and used to make a access to the abdomen by the operating surgeon's hand of hand-assisted laparoscopy surgery, even though use a different procedure to maintain the position of adjustment.

With particular reference to figures 5 and 6, the valve 13 comprises a fixed support 16 which can be connect by means of a bayonet coupling to the outer face of the round mobile nut 7. On the last one, in fact, they are contemplated radial extensions 17 defining circumferential grooves 18 with the outer face of the mobile round nut 7, inside which frictionally engage radial tongues 19 that extend from the outer wall of the fixed support 16. The tightness between the fixed support 16 and the mobile round nut 7 it is secured by a sealing ring 20 arranged between they. The valve 13 also comprises a round control nut 21 rotatably coupled inside the fixed support 16 and held in the desired angular position by means of arms flexible 22 extending axially from the fixed support 16. The arms 22 have internal radial extensions 23 the which are coupled in axial grooves 24 formed in the outer surface of the round control nut 21.

The valve plug 13 comprises a elastic membrane 25 having a resting position in a position toroidal with a cross section in "Omega", which is they keep tight on the inner walls of the nut control round 21 and fixed support 16, respectively, by half expansion rings 26 and 27 of rectangular section, cut laterally to allow flattening of the membrane against the walls of the round control nut 21 and the fixed support 16 without space.

By turning the round control nut 21 with with respect to the support 16, the flexible arms 22 bend, making that the extensions 23 move from a slot 24 to the another, so that the elastic membrane 25, due to the torsion to the which is subjected, closes radially like a diaphragm. With a appropriate turning angle of the round control nut 21, is it is possible to completely cover the valve hole 13, or partially cover it in the case where a trocar cannula must pass through said hole, tightening the membrane 25 around it and ensuring gas tightness and tightening constant axial

The extensible anchor guide according to the invention, in addition to having the diaphragm valve described above in  This document can be used naturally even in association with valves for trocars of other types, such as illustrated in figure 7.

The valve illustrated here is of the double type tightness: that is to say it has a first elastic shutter 26 with a flute mouth geometry that at rest remains in position closed by the pressure established in the cavity of the body. If an instrument is inserted, the flute mouth shutter 26 opens in correspondence with the longitudinal cuts, losing however the gas tightness. It is contemplated so both a second shutter 27, upstream of the first and formed by an elastic membrane with a calibrated drill to make a joint in a diameter of the particular instrument. Normally if you have to insert an instrument with different diameter, you must replace the second shutter block 27 fixed with a bayonet coupling to the first shutter. The double scheme shutter as illustrated allows instruments to be removed and inserted without losing tightness, while, when the instrument is inserted, the second shutter ensures the tightness radially forcing against the instrument. The system Valve described and illustrated in Figure 7 is the most widespread commercially, but there are many others, predominantly designed to accommodate instruments with different diameters, without the Need to exchange the second shutter. The instrument according to the invention it can accommodate, by means of an adapter appropriate, any commercial sealing system.

Naturally, the tubular body 1 of the guide Tensile anchor according to the invention can be made with a different number of cylindrical sectors with respect to what has been described and illustrated. In this way, it is possible to approach better to the circular shape of the hole made, although the cost of the instrument increases.

Variations or modifications can be made to the trocar anchor guide according to the present invention without therefore leaving the protective scope of the invention as set forth in the following claims.

Claims (8)

1. Anchoring guide for trocars for use in laparoscopic surgery comprising a tubular body (1) formed by a plurality of substantially circular sectors (1a), radially movable from and towards a longitudinal axis of said body between a first position, in which are each side by side according to a first substantially circular arrangement of diameter equal to that of said tubular body and a second position, in which they are equidistant from each other according to a second substantially circular arrangement of greater diameter than that of said first circular arrangement, anchoring means formed on the outer surface of said tubular body to fix said tubular body to an access hole to enter a body cavity, said plurality of sectors being rotatably connected with a support element (4) through respective arms (2) extending therefrom in a manner substantially tangential and manually operated means (7), mobilely connected to said support element, being additionally provided to move said sectors from said first to said second position and vice versa, said support element (4) being an annular body and is characterized in that said manually operated means comprise a movable round nut (7) that rotates coaxially in said annular body and thrust pins (10) that extend orthogonally from said movable round nut (7) and arranged in a way that interfere with said arms (2) during rotation on said round nut (7), the sliding of said push pins (10) along said arms (2) causing the angular displacement of said arms. 2. Anchor guide according to claim 1 in which said arms (2) have a curved profile. 3. Anchor guide according to claim 1 or 2 wherein said manually operated means also comprise locking pins (9) extending from said round nut mobile (7) and also adapted to interfere with said arms (2) from the opposite part of said push pins (10). 4. Anchor guide according to any of the previous claims wherein said arms (2) are housed coplanar inside said annular body (4). 5. Anchor guide according to any of the previous claims wherein said arms (2) are articulated to said support element (4) by means of respective articulation pins (3) that pass through said support element and coupled in respective notches circumferential (6) formed along said round nut mobile (7), reversible tightening means (8) of said pins leaning against said mobile round nut. 6. Anchor guide according to any of the previous claims in which a tube (14) may be fixed inside said tubular body (1) in a condition open, said tube being provided with two elastic membranes in disk shape (14a, 14b) that extend from its ends and that They can be folded inside. 7. Anchor guide according to any of the previous claims wherein said mobile round nut (7) comprises fixing means (17, 18) for a valve body (13). 8. Anchor guide according to claim 7 in which said valve body comprises a fixed support (16) the which can be reversibly attached to said round nut mobile (7) and a round control nut (21) articulated coupled to said fixed support (16) and held in a position desired angle by means of flexible arms (22) extending axially from the fixed support (16), said arms being provided with internal radial extensions (23) adapted for be coupled in axial grooves (24) formed on the edge of said round control nut (21).